This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Thursday, 6 January 2011

Conversation with a Moron

I recently had a bit of dialogue with a rare specimen of a human being on the comments page of the article linked above.

I decided to post about here because people who think like this are 100% responsible for the decline in Nursing care that we see today.

This person (I think it is a woman) seems to think that a Nurse can be overloaded with patients with no limits on numbers and acuity, and still function.

She thinks that most NHS nurses are incompetent because of the following list. (keep in mind that most NHS general ward RN's are taking on 15 patients each and that years of intense research have shown that the maximum number even the best nurse can take and not make mistakes is 4-6 on a general floor).

" I am often involved in investigating untoward clinical incidents. The majority of times they arise from a chain of small mistakes which when put together cause a very serious situation, much like the well know “Swiss cheese” model.

Many of these small mistakes are made by “experienced nurses” many that have good academic qualifications. Examples of these mistakes include:

• Omitting to administer prescribed medication

• Administering the wrong dose

• Failing to administer medication at the appropriate time

• Failing to report that medication has not been administered

• Administering medications to the wrong patient

• Leaving drugs potted up on bedside tables

• Failing to recognise a deteriorating patient

• Failure to record observations

• Failure to report a deterioration in patients condition

• Failure to rescue deteriorating patients

• Poor documentation

None of the above “require the person who is delivering the treatment to be extremely on the ball” and being “short staffed” or “underpaid” is not an excuse for failing to carry out basic duties which are what the above are.

To her it is as simple as "Nurses are crap and incompetent and no omissions and errors should occur matter how many patients have"

It is physically impossible to document, catch onto changes in condition and administer drugs on time and correctly when an RN has a patient load that is too high. I have worked enough 14 hour shifts without a break to know this is 100% true. I do not believe that a person is capable of investigating "untoward clinical errors" on a general ward properly or devising schemes to avoid future mistakes UNLESS HE/SHE HAS RECENT AND FREQUENT EXPERIENCE WORKING ON SAID WARD FOR FULL SHIFTS AS THE ONLY RN FOR 15 PATIENTS. This person is an example of why I feel that way.

Most hospitals in Britain have dangerous RN to patient staffing on their general wards. The formula that management uses to determine staffing levels is flawed. I have heard our chief exec, our nursing director, our matrons etc say that a ward is "sufficiently staffed" when it has one RN to 10 patients. This is, of course, wrong. That Nurse is going to make mistakes an fail. Throwing more apprentices and care assistants at the problem doesn't help when I am in the middle of a drug round and getting interrupted constantly during it to deal with things that only an RN can handle.

The thing about the NHS is that they overload their frontline RN's and put them in situations that no one could handle no matter how compassionate, intelligent, caring, or hardworking they happen to be. When untoward incidents occur they use it as an excuse to disrespect Nurses even more and cut them off from even more resources. It is a catch 22. Pretty soon we will have one RN running between five 30 bed wards and they will say that the bad care and omissions in care are down to her "laziness".

Do you see what kind of fucking clueless morons we have running the show. I have never seen a general medical ward in the NHS where the RN has less than 10 patients. Most of us have up to 20 patients per RN at a time. The powers that be have never even heard of safe staffing studies and they won't bother to look at them because they think all the problems are down to "bad nurses". And as a result they will continue to deny us the resources we need to do our jobs.

Nothing will ever improve until the dinosaurs working in the NHS that hold these ridiculous opinions start to die out. Until they do Nurses will not win and patient care will continue to deteriote despite Nurses working harder than ever.

When I tell colleagues abroad that over here in the NHS the RN takes 8,10,12,20 patients on a general medical ward without 24 hour pharmacy and other back up etc etc they want to know "how the hell are you people getting out of there at the end of the day without making 150 drug errors in one shift". The Nurses who have said this to me are award winners for bedside clinical excellence. Yet they would refuse to work in the NHS because they KNOW that they would make mistakes working in these kinds of conditions.

But our little commentator over at Nursing Times thinks that these mistakes and omissions are merely occuring because Nurses cannot be bothered with basic nursing or are uncaring. She is wrong on both accounts.

35 comments:

Anne, Anne, Anne. Didn't we pledge to one another sometime last year that the NT was full of shit and that we shoulden't go over there because they are all a bunch of tools who haven't seen the dirty side of a bedpan in years.

Because if we didn't, we should.

That stupid website blew up around about this time last year with degree drama and every other commenter was a male nurse now working in management who knows best for the NHS or a nurse who qualified over 101 years ago who thinks they know at all what frontline nurses have to put up with now.

It's the people who comment over on NT's website that will eat the NHS from the inside out. Nobody is doing themselves any favours over there by publishing "articles" about how they reckon NHS nurses are well within their limits. Then they allow people to comment who haven't worked on a ward in years going "here here!!! the problem is that there aint enough managers! MORE MANAGERS!" or "here here!!! the problem is that newly qualified nurses are inept and too posh to wash!" . WTF? I can't bear the hypocrisy over there!

Oh my god are you talking about the bedside manner article. I laughed so hard I wet myself.

How those people could think that nurses and doctors don't understand that our patients need time and emotional support is beyond. How they could not understand that we are in position to give that kind of support is also beyond me.

Anne I follow yourself, Pronurse and also go onto NT though I do find myself wanting to hit some of the people on NT some of them do speak some sense. I am actually getting to the stage I think a nursing strike would be a good idea. Or a work to rule. I am not even qualified yet but I am looking at jobs abroad but they tend to require a couple years experience before they will consider you. With a distinct lack of jobs in Scotland I am starting to wonder if I am going to get the experience I need.

I am sorry for the patients but I think we all just need to walk away. All at once. It might save lives in the future.

I had the commentator remind me that a coroner will hold the nurse herself responsible for drug errors etc without giving a goddman about how many other patients she has or how busy the ward was. I think she was trying to tell us we had better stop making mistakes or else.

The thing is we all ready KNOW that the coroner will nail our asses to a wall even though we were forced to take on more than we can handle! That is why we are all either getting the hell out of bedside nursing or this godforsaken country!!

1. The media is stupid as fuck.2. The public is stupid as fuck.3. The chief nurses and matrons haven't worked on a ward in years so they are also, stupid as fuck.

If we strike, the press and nhs seniors will really REALLY twist the reasons for the strike.

They won't talk about patient safety, ratios, ornurses being forced to work 14 hour shifts without food and water in order to avoid getting pulled up by a coroner and sent to jail. Hell even when Nurses do work 14 hour shifts without food and water and stay over another 2 hours unpaid to try and catch up things still happen that could get them nailed by the police/nmc/coronor.

We will see headlines like this rather than seeing the real issues addressed:

"Lazy Nurses who are too posh to wash and whom neglect and starve patients go on strike for better pay, killing thousands across Britain"

The public would suck it up even though they cause most of the drug errors by interrupting the nurses constantly during drug rounds....as in every 30 seconds. And they would be coming after us with torches and pitchforks. Must be nice for them you know, only working an 8 hour day and getting paid for it, getting to eat and pee at work and then slamming people who work 10 times harder for not being able to be 100 places at once Must be nice.

Personally I don't give a rats ass about pay. I just want safe working conditions. Safety would be my reason for striking.

The paperclip counters are just that. Total wastes of oxygen whose jobs could be done by a half-witted baboon.

Ten minutes in our job and they would be demanding admission to ITU with chipped nail polish. We had a saying at Shitford "The eight of the heels is inversely proportionate to the usefulness of the job"

I AGREE SHE IS WRONG ON ALL ACCOUNTS! I was fuming mad reading her comments, she(if she IS a nurse) clearly hasn't worked on an acute clinical ward in the last 10 years!

I left ward nursing because I could not safely look after 15 acute medical patients (on an MAU) without neglecting basic care or risking making serious errors.

The NT commentator is a TWAT for implying that I am a lesser nurse for not being able to do that. I GUARANTEE THAT SHE COULDN'T DO IT EITHER...AND I CHALLENGE HER TO APPLY FOR SUCH A JOB AND DO IT FOR 3 MONTHs.

Managers in the Blood Donation Service are equally out of touch. Three years ago it became almost impossible to donate without an appointment.Last month they were telling us stocks were low and would donors make an effort to attend. One who did wrote to The Times saying he was turned away from a session as they don't do walk-ins any more. A letter from the Deputy Director saying that this was untrue. I made two attempts to donate last month, but they couldn't take me.There was even a notice up asking people not to abuse the staff. These were blood donors FFS, not drunken yobs at A&E.

Wow, 10-15 patients to 1 nurse is a 'nut job' of an assignment, even if you have nurses aids to help you. I was frustrated with my jobs in the USA for the same reasons you describe here, but smaller patient loads. I've worked 8 to 1 no aids or assistive personnel on a post op orthopedic floor and 5 to 1 post op CABG, very dangerous stuff to be doing with those small of numbers. Minimal care is given in most places because they enslave us by making us pay $40K for school and then there is no other way to pay it back but work in shitty hospitals. But I'll agree that ya'll have it worse and you really should go on strike, it's the safest thing for you and your patients.

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.